The presence of diastolic and systolic dysfunction in patients with impaired relaxation filling pattern

Abstract

Impaired relaxation filling pattern in the presence of preserved left ventricular ejection fraction is a common finding which is ascribed to early diastolic dysfunction. We thought to determine the distribution of various markers of systolic and diastolic dysfunction in these patients. A total of 106 patients were included in this retrospective observational study. Diastolic dysfunction was defined using the American Society of Echocardiography recommendations ("50% rule"). The systolic dysfunction was evaluated by global longitudinal strain and circumferential strain. For further analysis, the patients were divided into the lower strain (lower tertile) and higher strain (upper tertiles) groups based on longitudinal strain. There were marked differences between the groups in essential echocardiographic parameters. Patients in the lower strain group were more likely to have definite diastolic dysfunction (23% vs 7%, P<.01) and less likely to have normal diastolic function (54% vs 80%, P<.01). They also showed lower circumferential strain (-21.2% vs -25.7%, P<.01). In multivariate analysis, left atrial enlargement (odds ratio (OR) 4.6, 95% confidence interval (CI) 1.2-17.1), left ventricular mass index (OR 1.03, 95% CI 1.0-1.1), left ventricular end-diastolic volume (OR 1.1, 95% CI 1.0-1.1), and E-wave deceleration time (OR 0.99, 95% CI 0.98-1.0) were independently associated with lower global longitudinal strain. Patients with impaired relaxation filling pattern in the presence of preserved left ventricular ejection fraction have a wide spectrum of left ventricular systolic and diastolic performance abnormalities. Isolated assessment of diastolic dysfunction may not fully characterize this group of patients.